Clinical features and prevalence of gastroesophageal reflux disease in infants attending a pediatric gastroenterology reference service

Abstract

-Context -In infants, it is not always easy to distinguish between pathological and physiological gastroesophageal reflux based only on clinical criteria. In Brazil, studies about gastroesophageal reflux disease in infants are few and are even rare those that used prolonged esophageal pH monitoring for its evaluation. Objective -To describe the clinical features of gastroesophageal reflux disease and to determine its prevalence in infants with gastroesophageal reflux attending a tertiary Pediatric Gastroenterology Service and submitted to esophageal pH monitoring for investigation. Methods -Descriptive study in 307 infants in whom esophageal pH monitoring (Mark III Digitrapper, Synectics Medical AB, Sweden) was performed during the period December, 1998-December, 2008. The clinical features studied were age group (1-12 months and 13-24 months), and clinical manifestations that motivated the indication of pH monitoring. Results -One hundred twenty-four (40.4%) were female and 183 (59.6%) male with mean age 12.2 ± 6.2 months (1-23 months). The prevalence of gastroesophageal reflux disease was 18.2% (56/307). One hundred forty-eight (48.2%) were 1-12 months old and 159 (51.8%), 13-24 months. No significant difference was found between the prevalence of these two age groups (P = 0.3006). Gastroesophageal reflux disease was more frequent in those with digestive manifestations (24.2%), crisis of cyanosis/apnea (23.8%) and mixed manifestations (21.5%). Respiratory manifestations were the most frequent indication (39.1%) of pH monitoring. However, the prevalence of gastroesophageal reflux disease was lower (12.5%) in this group compared with in those with digestive manifestations (P = 0.0574), crisis of cyanosis/apnea (P = 0.0882) and mixed manifestations (P = 0.1377). All infants that presented clinical manifestations as crisis of cyanosis/apnea and abnormal pH-metry were ≤ 3 months of age. Conclusions -In our Service, the prevalence of gastroesophageal reflux disease associated with acid reflux in infants revealed elevated. Infants with crisis of cyanosis/apnea constitute risk population for gastroesophageal reflux disease in which diagnostic investigation needs to be considered.

Infants under 3 months old with cyanosis at the emergency room: could it be gastroesophageal reflux?

“…Koda et al . described abnormal esophageal pH monitoring in 23.8% of infants with a history of cyanotic episodes . We found a higher prevalence of GERD (74.6%) in this group.…”

“…Respiratory manifestations are the most frequent reason for monitoring esophageal pH . During sleep, a normal infant does not show acid GER episodes, particularly more than 2 hours after their last meal.…”

Mast Cells Distinguish Eosinophilic Esophagitis in Pediatric Patients

“…Studies had been performed accordingly described by Koda and co-workers (12) . This project was approved by the Medical Research Ethics Committee of the university hospital.…”

Gastroesophageal Reflux in Critically Ill Children: A Review

“…GER in childhood usually resolves spontaneously between 12 and 18 months of age due to growth of the esophagus, an increase in LES tone, a solid diet, and less time spent in the supine position [16, 17]. …”